The Ohio Democrat. (Logan, O. [Ohio]) 1886-1906, 1887-03-05
CURE OE hARELlP.
Medical Science as Applied to RemedyIns
This Unsightly Maiformation

This Unsightiy Maiformation.
Harelip Is too common defornity
to require any extended notice as to the
appearances presented. However, as
the operation for its relief is frequently
done in slip-shod, imperfect manner.
1t may not be amiss to give brief
notice of this affection. 1t is due to an
arrest of development, and consists OF
one or two assures through the upper
lip, frequently extending through the
rim of bone in which the upper teeth
are implanted, and this may reach
backward through both the hard and
soft palate. When it is "single" the
cleft is located to one side, so that the
gap extends into one nostril, leaving
one side of the upper lip wider than the
other. Single harelip may not involve
the bony parts, or there may be an ex-
tensive deficiency in the palate. 1t is
more frequently upon the left than
right side. In double harelip the bones
are included, and the deficiency may be
so great that the lips seem never to
have been formed and the little piece
of bone between the two clefts may be
displaced and appear attached to the
tip of the nose. No one knows any
reason why this arrest of development
should occur, but the cases are not at
all infrcquent in which other members
of the same family are afflicted in the
same way; hence there is some reason
| for believing, in these instances, at
least. that hereditary influences have
been in action.
There is some difference of opinion
as to the time an operation for the re-
lief of the deformity should be attempted.
1t seems that it should be done before
the teeth make their appearance. When
the child is about four months old is a
very good time for its performance. If
there be projection of the intermediate
piece of bone, it should be done much
earlier, as the bones of the Jaws are
softer and more yielding, and the pres
sure of the lip thus formed has II tend
cncy to lessen the deformty of the roof
of the mouth the more the earlier it is
done. The third or fourth week of life
is an appropriate time for the operation
in such cases. If it has been put off
until the teeth begin to appear, it should
be deferred until the last of the third
year, as while the process of tccthing
is in progress children are prone to
convulsions and other nervous distur-
Dances from moderate irritations.
The operation itself is sufficiently
simple. The child is put into a broad
bandage so that the limbs are all con-
fined, then giving ether or chloroform,
placed upon a table or in the arms of
an assistant, and kept upon its back.
A thread is then passed through the lip,
close to its red margin, to one side of
the fissurc, and made into loop about
six inches long, another like it is in
serted on the other side; these enable
traction to be made, to secure proper
position. The edges of the tssurc arc
then pared or ''freshened," after the
lip has been freed from attachments on
the under side which might interfere
with drawing the parts easily into q
natural position. If there is bleeding
of any amount, it is easily arrested by
pressure of the fingers. The freshenct
surfaces are brought together and held
there by a pin passed deeply through
transvcrscly. about midway between
the nose and edge of the lip. This il
secured by turns of darning cotton
passed alternately over the ends of til,
pin which project, forming figure o
s." Care must be taken when the
two portions of lip are thus drawn to
gether to have them at the same level
otherwise there will be an ugly appear
ance of the two parts of the lip not being
of the same length.
A second pin should be passed through
from side to side, secured in the same
way, Just at the junction of the skin
with the vermillion edge of the lip. A
fine silk stitch should be put in close tc
the nose, effectually closing the upper
lower extremity thereof; otherwise
there will be an unsightly notch left al
the edge of the lip, which n secont
operation may be required to close. The
silk stitches are often omitted, which
accounts for some imperfect results
The pins and stitches may be taken on
on the fourth or fifth day. Then stril
of adhesive plaster, narrow along tho
lip, broader at the ends, extending
across from one cheek to the other
should be applied, and renewed as il
becomes loosened for two or three weeks
Until the pins and stitches are removed
no plaster should be used. as it cause:
unnecessary irritation, prevents con
stant inspection, and interferes will
perfect cleanliness. Afterwards it i.
Indispensable.
In ordinary double harelip one of the
assures may be closed first, and after i
has firmly united the same process may
be applied to the second. Sometime.
the portions removed to allow the unior
of the edges of the tissure are preserved
still attached at their lower ends, ant
then trimmed to a proper length an(
stitched into place to effectively clos,
the notch at the lower end of the clef
in the lip. If this projects too far afte
healing is perfect it may be pared dowl
to proper dimensions. 1t may be nee
essary to relieve undue tension of tn,
parts on each side of the fissure, whicl
would interfere with healing by incis
ions made outwards into the cheek
from the junction of the lip with th'